Dallas Elise Clark, MD
Individual provider Active NPI Family Medicine Physician · Red Lodge, MT
NPI 1669822664 · NPPES record last updated Sep 6, 2019
Key facts
- NPI
- 1669822664
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- MED-PHYS-LIC-77353 (MT)
- Practice address
- 2525 N Broadway Ave
Red Lodge, MT 59068 - Phone
- (406) 446-2345
- NPI assigned
- Jun 21, 2016
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Hospital & facility affiliations 11
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- University of Washington School of Medicine, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Memorial Hospital Association
Practice addresses (Care Compare)
2525 N Broadway Ave
Red Lodge, MT 59068-9222
Phone (406) 446-2345
Hospital & facility affiliations
- Beartooth Billings Clinic Home Care
- Beartooth Billings Clinic
- Billings Clinic Hospital
- Stillwater Billings Clinic
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20191024001931 | MT | Practitioner - Family Practice | 6103158142 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Memorial Hospital Association | Current |
Accepting new patients | |
| Memorial Hospital Association | Current |
Accepting new patients | |
| Memorial Hospital Association | Current |
Accepting new patients | |
| Memorial Hospital Association | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MED-PHYS-LIC-77353 | MT | Yes |
Addresses
Primary practice location
2525 N Broadway Ave
Red Lodge, MT 59068
Mailing address
2525 N Broadway Ave
Red Lodge, MT 59068-9222
Phone (406) 446-2345
Other practice location 1
401 Railroad St W
Missoula, MT 59802-4109
Phone (406) 258-4789
Other providers in Red Lodge, MT
- Amy Brehm
- Kayla Marie Briggs
- Gregory David Burfeind
- Carbon County Senior Care, LLC
- City of Red Lodge
- County of Carbon
- Jordan Thomas Dobmeier
- Kathleen Joyce Durant
- Craig C Erickson
- Shirley A Erickson
All providers in Red Lodge, MT · Family Medicine Physician in Montana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 6, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.